Indications Arthroscopy is a surgical technique that can be applied to perform the following types of procedures: Diagnostic surgery Meniscal repair or resection Removal of loose bodies ACL and PCL reconstruction Synovial biopsy or synovectomy Chondral defect repair, including microfracture Osteochondritis dissecans treatment Knee debridement for osteoarthritis controversial whether or not it provides symptomatic relief Positioning and Scope Insertion Patient placed supine with ability to flex the knee leg holder or post has benefit of allowing valgus stress but makes figure-four position more difficult Place tourniquet (important for safety, but often not inflated) Make anterolateral incision over soft spot of knee vertical incisions have advantage of increased superior-inferior mobility of instruments horizontal incisions have advantage of increased medial-lateral mobility of instruments Insert trochar into capsule advance blade into capsule then follow with trochar do with knee flexed Advance trochar into suprapatellar pouch with knee straightened Primary Portals Anterolateral function standard portal used as the primary viewing portal location & technique make with knee in flexion, adjacent to patellar tendon over soft spot on joint line Anteromedial function standard portal used as the primary instrumentation portal location & technique make with knee in flexion, adjacent to patellar tendon over soft spot on joint line Superomedial function accessory portal most commonly used for water in/out flow location & technique make with knee in extension Superolateral function accessory portal most commonly used for water in/out flow location & technique make with knee in extension most common site for aspiration or injection Secondary Portals Posteromedial portal function helps visualize posterior horn and PCL location & technique 1 cm above joint line behind the MCL Posterolateral portal function helps visualize posterior horn and PCL location & technique 1 cm above joint line between LCL and biceps tendon Transpatellar portal function used for central viewing or grabbing location & technique 1 cm distal to patella and splits the patellar tendon do not use if performing a bone-patella-bone graft harvest Proximal superomedial portal function used for anterior compartment visualization location & technique 4 cm proximal to patella Far medial and far lateral portals function used for accessory instrument placement often helpful for loose body removal location & technique place where can be best utilized for need function used for accessory instrument placement often helpful for loose body removal location & technique place where can be best utilized for need function used for accessory instrument placement often helpful for loose body removal location & technique place where can be best utilized for need Diagnostic Scope Should systematically check the following locations and structures with knee fully extended start in suprapatellar pouch loose bodies patellofemoral joint patellofemoral cartilage patellofemoral tracking trochlear groove lateral gutter insertion of popliteus lateral compartment anterior horn of lateral meniscus medial gutter with knee flexed to 90 move to medial compartment medial meniscus medial femoral condyle cartilage medial tibial plateau cartilage intercondylar notch ACL PCL posteromedial corner best seen with 70 degree scope placed through notch (Modified Gillquist view) with knee in figure-four position finish in lateral compartment lateral meniscus popliteal hiatus lateral femoral condyle cartilage lateral tibial plateau cartilage Complications Iatrogenic articular cartilage damage is most common complication Hemarthrosis Neurovascular injury posteromedial portal saphenous nerve posterolateral portal common peroneal nerve